Managers of the Patient Protection and Affordable Care Act (PPACA) public exchanges have shown that millions of Americans are willing to buy health insurance from new public programs -- even if the programs don't work very well.
The PPACA public exchange open enrollment period for individual commercial "qualified health plan" (QHP) coverage started Oct. 1 and, technically, is set to end at 11:59 p.m. today.
The U.S. Department of Health and Human Services (HHS) officially gave managers of the state-based Cover Oregon exchange -- an exchange with enthusiastic local support but a dysfunctional website -- permission to extend its open enrollment until April 30.
In most of the rest of the country, consumers can get until April 15 to complete their individual QHP applications by simply checking a box indicating that they had started to apply for coverage, or tried to start to apply, by end of today.
Despite going through months of enrollment system glitches and continuing to face lingering application processing system glitches, the 37 exchanges run by the U.S. Department of Health and Human Services (HHS) reported that 6 million people had selected QHP coverage by Thursday.
The state-based Covered California exchange increased enrollment about 20 percent, to 1.2 million, between March 17 and today, and that exchange seems to be on track to increase enrollment to at least 1.4 million in the next few days.
The California exchange enrollment site has set account creation records on five of the past six days.
Peter Lee, the exchange executive director, described the open enrollment period as a "historic opportunity" for state residents to get themselves and their loved ones covered.
"If you already have insurance, call those you know and urge them to get enrolled in these final hours," Lee said.
Charles Gaba, a PPACA enrollment watcher, has predicted on his blog that the total number of people who have picked QHP coverage nationwide could reach 7 million as early as today.
Applications already in the pipeline could drive the total to 8 million by the unofficial new April 15 application deadline.
Obama administration officials said they believe the more recent enrollees are younger, and likely healthier, than consumers who signed up for coverage earlier.
Consumers can use many different reasons to get permission to buy individual QHP coverage through "special enrollment periods" after April 15. A consumer could get a special enrollment period by moving to an area with different coverage options, or simply alleging that a navigator, exchange broker or insurer made an error.
Jeff Smedsrud, a longtime health care marketing specialist and the new chief executive officer of HealthCare Inc., recently estimated that special enrollment period business volume could amount to 30 percent to 50 percent of the open enrollment period volume. If that ratio holds true, overall exchange QHP enrollment could increase to 9 million to 12 million by the end of the year.
But the Centers for Medicare & Medicaid Services (CMS), the HHS agency in charge of the exchange program, attracted only about 50,000 brokers to serve enrollees. At one point, the agency had speculated in paperwork review filings that it could attract as many as 250,000 exchange brokers.
State and federal officials have expressed uncertainty about how much funding will be available to keep exchange helpers to help QHP enrollees with problems that crop up with in-force QHP coverage from April 1 through Nov. 15, the start of the 2015 QHP open enrollment period.
Brokers and nonprofit navigators have reported encountering many consumers facing serious problems with obtaining QHP cards, finding providers who are really in the QHP networks, and getting QHPs to pay claims.
In Nevada, for example, a representative from the Nevada Health Co-Op told her state's exchange board a few weeks ago that her plan believed it had hundreds of new enrollees stranded in a state of application processing limbo, with no way for the plan to manage the enrollees' care, or even to get their contact information.
The Congressional Budget Office predicted at one point that the QHPs could attract 7 million enrollees in 2014.
Dr. Jay Bhattacharya of Stanford School of Medicine has estimated that the exchange plans could eventually attract as many as 37 million individual and group enrollees.
Representatives for brokers, navigators and other exchange helpers are arguing that one key to keeping consumers in the QHPs and achieving the enrollment levels will be to make sure enough exchange helpers are available to help the enrollees clear up coverage problems.